The right ventricle was exposed by gentle downward traction on the diaphragm using either a suction cannula or a Langenbeck retractor. The ventricular pacing lead buttons were sutured to the diaphragmatic portion of the right ventricle using two interrupted 5/0 polypropylene sutures each (Figure).
Exposure was facilitated by placement of a self-retaining retractor and two Langenbeck retractors: one lifting the sternum upwards and the other retracting the diaphragmatic pericardium downwards.
An example of a hand held retractor would be that of a Langenbeck retractor
, whereas a Turner Warwick retractor would be an example of a self retaining retractor.
Further flexion and the use of Langenbeck retractors
for the anterior soft-tissue flap allow the exposure of the anterior capsule.
The remaining theatre was home to the general surgeons wielding Langenbeck retractors
, Spencer Wells and Moyhihan forceps, McIndoe's scissors and numerous other eponymous instruments.